The Hawai‘i Department of Health (DOH) is partnering with Diagnostic Laboratory Services (DLS) and Clinical Laboratories of Hawaiʻi (CLH) to encourage providers to “reflex” hepatitis C testing, which will help more people get diagnosed with and cured of hepatitis C.

Currently, hepatitis C is screened through antibody testing, but requires an RNA test to confirm infection. Reflex testing assures that when an antibody screening test is positive, the specimen is automatically processed by the laboratory to confirm hepatitis C infection using an RNA test.  DOH, DLS, and CLH urge healthcare providers to order the “reflex” option when screening for hepatitis C, to ensure more accurate and timely diagnoses.

The Centers for Disease Control and Prevention (CDC) currently recommends that all adults over age 18 get tested for hepatitis C at least once, regardless of any known risk. Testing for hepatitis C involves a simple blood draw and can be requested through healthcare providers.

“By promoting the option to ‘reflex’ hepatitis C screening tests to confirmatory tests, our local labs are helping to improve the pathway to cure for many people in Hawaiʻi,” said Thaddeus Pham, DOH Viral Hepatitis Prevention Coordinator. “Our labs have always been essential partners in public health, and we are excited and grateful for their partnership to ensure more people get timely access to hepatitis C curative treatment, starting with diagnosis.”

“Diagnostic Laboratory Services, Inc. (DLS) is proud to partner with the DOH to help our community fight liver disease and liver cancer through ‘reflex’ hepatitis C testing,” said Mark Wasielewski, President of Diagnostic Laboratory Service, Inc. “It is only by working together that we can realize a Hep Free 2030 Hawai‘i.”

“Clinical Labs of Hawaii is proud to support this initiative and partner with the DOH and Hawaii’s healthcare providers to promote confirmatory testing for hepatitis C,” said Dr. Owen Chan, Medical Director at Clinical Labs of Hawaii. “Hepatitis C, if caught early via laboratory testing, is treatable and many downstream illnesses can be prevented.”

Hepatitis C is primarily spread by blood-to-blood transmission, especially through shared injection equipment.

• October is Liver Cancer Awareness Month and Hawaiʻi has one of the highest rates of liver cancer in the U.S. The leading causes are viral hepatitis B and C. Across the U.S., new cases of hepatitis C are on the rise, increasing by more than 60% from 2015 to 2019.
• Almost half of people with hepatitis C are unaware of their infection. Timely and complete testing is the first step to accessing curative treatment. However, one in three people with a positive HCV-antibody test do not receive a confirmatory RNA test.
• Hepatitis C is curable for most people within 12 weeks. A positive test for HCV RNA is needed to diagnose current HCV infection and initiate oral curative treatment. Without treatment, 15-20% of adults with chronic HCV infection will develop progressive liver fibrosis and cirrhosis which can lead to death.

Both the CDC and the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) recognize HCV antibody screening followed by a confirmatory RNA test as best practice to identify hepatitis C infection.

Both DLS and CLH have the option for positive HCV antibody tests to be “reflexed” to HCV RNA test automatically from the same blood sample. (CLH Test Code: HCVABR (0437); DLS Test Code: 542R)

This partnership aligns with Hep Free 2030, the statewide strategy to eliminate viral hepatitis in Hawaiʻi by 2030, which was developed by DOH in collaboration with Hep Free Hawaiʻi and over 160 community stakeholders. For more information on hepatitis elimination efforts in Hawaiʻi, go to www.hepfreehawaii.org/hep-free-2030.